Posted on 08/31/2023 8:19:34 PM PDT by ConservativeMind
Switching vitamin K antagonist (VKA) treatment to a non-vitamin K antagonist oral anticoagulant (NOAC) in frail elderly patients with atrial fibrillation is associated with more bleeding complications compared to continuing VKA treatment. That's the finding of late breaking research.
In newly diagnosed patients with atrial fibrillation, NOACs are preferred over VKAs for the prevention of stroke. In atrial fibrillation patients already using a VKA, ESC guidelines recommend considering switching to a NOAC, especially if the time in therapeutic range is not well-controlled despite good drug adherence.
The FRAIL-AF trial investigated whether switching VKA treatment to NOAC treatment was superior in terms of major and/or clinically relevant non-major bleeding complications in frail elderly patients with atrial fibrillation. Patients were at least 75 years of age, had a Groningen Frailty Indicator score of 3 or higher, and were currently managed with VKAs.
Between January 2018 and April 2022, a total of 1,330 patients were randomized. The mean age was 83 years and 38.8% were women. After 163 primary outcome events (101 in the switch arm, 62 in the continue arm), the trial was stopped for futility on advice from the Data Safety and Monitoring Board following a prespecified futility analysis. The HR for the primary outcome of major or clinically relevant non-major bleeding was 1.69 (95% confidence interval [CI] 1.23 to 2.32) for switching to a NOAC relative to continuing a VKA. The HR for thromboembolic events was 1.26 (95% CI 0.60 to 2.61).
Regarding secondary outcomes, 16 thromboembolic events occurred in the NOAC arm versus 13 in the VKA arm, yielding incidence rates of 2.6 (95% CI 1.5 to 4.3) and 2.1 (95% CI 1.1 to 3.6) per 100 patient-years, respectively.
(Excerpt) Read more at medicalxpress.com ...
I had to look up to find the drugs in each class:
Warfarin, the most frequently used oral VKA in the United States, inhibits the vitamin K-dependent carboxylation of coagulation factors II, VII, IX, and X and proteins C and S.
There are currently four NOACs available for patients with atrial fibrillation: dabigatran (Pradaxa®), rivaroxaban (Xarelto®), apixaban (Eliquis®), and edoxaban (Lixiana [Europe/Asia], Savaysa [Nth Am]. NOACs are the first-line treatment for most patients with venous thromboembolism (VTE) and for stroke prevention in atrial fibrillation (AF). NOACs have a lower propensity for drug and food interactions compared to vitamin K antagonists (VKAs) due to their individual coagulation proteins target and to the administration in fixed-dose without requiring routine coagulation monitoring.
Note that Vitamin K2 and D3 are essential for keeping calcium in the bones and out of the blood vessel walls, so a Vitamin K antagonist might not be a good thing for older patients.
This is saying to keep your old generic warfarin.
This doesn’t help a drug company.
Thank you, when a-fib was first diagnosed my cardiologist prescribed Predaxa and after a few months I had developed stroke like symptoms and was admitted. They found subdural bleeding and had to wait 24 hours for the predaxa to be out of my system for the brain surgery. During that time they thought I might not make it. But this was repeated later with Warfarin. It turns out that I was going to have brain bleeds on both types of blood thinner.
The solution after much trouble was to use a clamp on the LAA in the heart that produces blood clots thought to be the main cause of a-fib induced strokes.
Even later we learned that the main damage to my body parts was due to obstructive sleep apnea. Something that I have had for a long time but was only recently something that MDs had treatments for and thus did not prescribe sleep studies.
I would suggest that sleep apnea is a root cause type of ilness. May have caused the a-fib too, BTW, I still have a-fib, always will.
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Plus the hassle of the constant testing. Prothrombin time test
Warfarin side effects: Watch for interactions
If it's got to come from a Pharmacy the there's a drug company involved.
I had one heart event last February. Racing heart 169 beats a minute. They put me on Metoprolol Tartrate and Xarelto and continued my high blood pressure meds. Tests showed no stress or blockages. Xerelto is $500 a month after insurance. I have had no further heart issues since February so I am planning on asking the doctor to take me off of the heart meds and blood thinner. If you nick yourself shaving God help you! I hate these medications. I never had swollen ankles until they put me on this crap.
If the doctor can’t take me off the meds then I am going to Warfin because I can’t pay $500 a month.
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